| NPI | 1649794645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE LYNN BERUBE Owner/President 719-999-1220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX DT00673) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2022-07-21 |